Welcome to the Acción Mutua web-seminar Latino Immigrant Day by pmv10607


									 Welcome to the Acción Mutua web-seminar
Latino Immigrant Day Laborers & HIV

Before we begin, a little about our format
 Presentation by seminar speaker ≈ 40 min
 Question and answer session ≈ 20 min
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         Acción Mutua

is a capacity building assistance (CBA)
               program of
        AIDS Project Los Angeles
        in collaboration with the
        César E. Chávez Institute
    of San Francisco State University
Funded by the Centers for Disease Control
            and Prevention
Latino Immigrant Day Laborers & HIV

    Paula Worby, DrPH, MPH
        Associate Director
       Multicultural Institute

Focus of today‟s presentation

 Learning Objectives
  Who are day laborers
  Direct HIV risks
  Background factors affecting risk
  Maximizing assets for prevention
The reason I came to the U.S. was to look
 for a better life… but once you‟re here,
 there are all kinds of problems like
 loneliness, depression, separation from
 your family. One can fall into depression
 and when… depressed, then you resort
 to alcoholism and drugs…and then you
 get more problems… You can forget the
 reason you came here in the first place…
      Organista, Alvarado, Balblutin-Burnham, Worby and Martinez (2006)
Who are day laborers
 Recent immigrants from
   different countries
 Construction, painting and
 Higher hourly wages but
   irregular work
 Some move on, others are
 117,000 to 260,000 workers   PHOTO/MEGAN MCCALL,
                                 Daily Californian 2001
   seek work daily
Who are day laborers

  Almost exclusively male (98%)
  Majority without work authorization (75%)
  All low-income

  National Day Labor Study 2004-2005 (sampling of 264 sites in 20 states)
Who are day laborers

    Diverse
      countries of origin
      time in U.S.

      ages

      education

      community involvement

      work skills

      other languages/indigenous identity

  National Day Labor Study 2004-2005 (sampling of 264 sites in 20 states)
County of origin
Years of residence in the U.S.
Age range


                                               39%            Ages 18-29
    20%                                                       Ages 30-39
                                                              Ages 40-49
                                                              Ages 50+


  Source: National Day Labor Study; personal communication Enriquez-Haass, 2007
Mapping HIV risk

   (unsafe sex &   MEDIATORS
Context matters….

   Photo: Erik Oeverndiek/San Mateo Daily Journal
Greater Context (the Setup)

  Discrimination (undervalued)
  Loneliness, sadness (far from home)
  Financial hardships (overwhelming debts)
  Limited housing options
  Difficult, painful, dangerous work
  Pressure to not fail family
  Lack of English imposes limits

 “There are guys who lose morale, you
   understand? The only thing they do is
   drink, smoke marihuana. Why? To
   forget, you know, to forget a little while
   that they have problems because
   everyone has a bunch of problems—pay
   the rent, pay the bills, send money to
  Worby (2002)
…and resilience

 “You can get to the point where you don‟t
   have anything, not even to eat...you feel
   so desperate, so upset. You walk along
   and don‟t know what to do you are so
   desperate. Then later, you find some
   friend who helps you and it makes you
   think, you feel so good again...”

  Organista (2002 unpublished)

 Need intimacy, pleasure, distraction
 Male bonding and avoiding boredom
  (drinking and seeking sex)
 Can‟t escape negative peers
 Desperate measures to get cash
 Pathways to the “fall into vice”
  (“caerse en vicio”)
“Because there is a lot of—what would
 you say—a lot of vices. It‟s very easy to
 buy cigarettes here, a beer or whatever,
 cocaine, heroin. This is what I‟ve
 observed and really that is why I say that
 life [in the U.S.] is very nice but it is very
 Worby (2002)
Mediating influences (the causes)

  Which   sex partners
  Control & expectations about
   protection (condoms)
  Alcohol and/or drug use with sex
  Injection drug use
Sexual contact with women

 Sexworkers‟ availability
 Men arriving single or separated
 Men with partners or families at home
   Challenges to remain faithful despite good
   History of non-monogamy

   Estrangement over time
“The problem is that at times you
  have to have relations with a
  prostitute because, what are you
  going to do? You can‟t flirt with
  someone because here before you
  know it they‟ll want to have the
  police after you. It is really different,
  you know?”
Organista, Alvarado, Balblutin-Burnham, Worby and Martinez (2006)
Sexual contact between men

 Stigmatized and hidden
 Not determined by sexual identity
 Migrating away from cultural norms
 New chances to explore
 Survival sex (money for sex)
“My friends had homosexual friends,
  but they had them only so they
  could give them oral sex, not to
  have sexual relations…”
Gonzalez-Lopez (2005)
Alcohol and drug use

      Not everyone drinks
      Heavy drinking & weekend

 Alcoholgoes with sex “to relax”
 Marijuana versus hard drug use
Condom use

  Low or inconsistent use
  Assuming which women are „clean‟
  Condoms for- „other‟ partners
  (not for main partner)
  Men   picking up men at day laborer
  STD history
“I did use [condoms], but only a few
  times …90% but not 100% and
  wouldn‟t use any with a woman that
  I knew.
  The risk was when I got drunk; I
  wouldn‟t use any.”
Injection drug use

  Heavy drug use ≠ regular at day labor
  But some drug users are
   former day laborers

 Providers can ask about:
  Injections used in self medical care
Direct risk (the result)

   (Unsafe sex & IDU)   Alcohol/drugs with sex?
                        Which sex partners?
                        Control over encounters?
Positive approaches

 Building on day laborers’
 individual strengths
 and community

  Photo: Multicultural Institute 2008
Tips for agencies

 Reinforcing what already works:
  Staying well is best way to help families
  Communicating back home
  Obtaining safe work safely
  Finding decent housing & housemates
  Health, legal, and educational services
    that match needs
Photo: Multicultural Institute 2008
Tips for agencies

 Reinforcing what works for communities:
  Mutual helping
  Peer information networks
  Hometown and family networks
  Working through trusted organizations
  Connecting through cultural and sports
    activities, church communities
Photo: Multicultural Institute 2007
Tips for agencies

 Service delivery in general:
 Sensitivity    and language skills
  of all staff

 Bring services to
  workers instead of
  bringing workers to
Service delivery in general (cont.)

  Flexible requirements &
  Limited usefulness of most written
  Mix it up! stories, movies, skits,
   music triggers for discussion
Photo: Multicultural Institute 2007
HIV prevention education

  Address  common fears and
   misunderstandings as a given
  Peer influence vs. influential “experts”
  Good intentions vs. actual behaviors
  Assume sexual activity but reaffirm
   those with other choices
Institute 2005
iGracias ~ Thank You!

 Questions & Answers
Thanks for Your Participation

      For more information or to learn
  how to receive CBA services, contact us at:
   Future Acción Mutua web seminars:
   October 2, 2008 11am (PT)
        HIV/AIDS Stigma in the Latino Community, Dr. Brit Rios-Ellis
   November 13, 2008 11am (PT)
        Substance Use and HIV: An Overview, Paul Simons
    Please register at: accionmutua@apla.org

   For questions about today’s seminar
   Please contact Dr. Worby: paula@mionline.org

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